Menopause and secondary amenorrhoea Flashcards
average age of menopause
51
How long does the perimenopause usually last?
5 years before the menopause
What is known as premature menopause?
40 or less
Cause of menopause
ovarian insufficiency - oestradiol falls and FSH rises
Other source of oestradiol in ovarian sufficiency with menopause
peripheral conversion of adrenal androgens in fat
What may bring on menopause?
oophorectomy, chemo, radiotherapy
symptoms of menopause
vasomotor - hot flushes vaginal dryness and soreness mood change and poor memory low libido muscle and joint pains
Risk factors of osteoporosis
thin, Caucasian, smokers, alcohol, positive FH, amenorrhoea, malabsorption, steroids, hyperthyroid
Prevention and treatment of osteoporosis
calcium, Vit D, bisphosphonates, exercise, HRT, teriparatide, denosumab monoclonal ab
Local treatment of menopause symptoms
vaginal oestrogen pessary/ring/cream
Systemic HRT
oestrogen only if no uterus
oestrogen and progestogen if uterus present
Advantage of transdermal systemic HRT
avoids first pass so less risk of VTE
What types of oestrogen and progestogen HRT is there?
progestogen oral, transdermal or LNG IUS
CI to HRT
current hormone dependent breast or endometrial ca
current active liver disease
un investigated abnormal bleeding
What things should you seek advice on before starting someone on HRT?
previous VTE, thrombophilia or FH of VTE
previous breast or endometrial ca
2 methods of combined E+P HRT
cyclical or continuous
cyclical combined HRT
14 days E and 14 days E+P
withdrawl bleed
Who would you use cyclical combined HRT in?
still some ovarian function eg perimenopause
continuous combined HRT
28 days E+P
who would you use continuous combined HRT in?
no ovarian function eg >1 year after menopause
SERMS
E effect on some selected organs eg tibolone
Are antidepressants helpful with menopause symptoms?
no
Natural methods for menopause symptoms
phytoestrogen/herbs eg red clover/hypnotherapy/exercise/CBT
Benefits of HRT
vasomotor
local genital symptoms
osteoporosis
Risk of HRT
breast cancer if combined HRT
ovarian cancer
VTE, CVA
How often to review HRT for vasomotor symptoms
annually
What age do benefits of HRT outweigh the risks for ovarian insufficiency?
50
treatment for osteoporosis and vaginal dryness
bisphosphonates
vaginal oestrogen
Andropause
testosterone falls by 1% every year after 30 and DHEA falls
fertility remains as it is a gradual change
secondary amenorrhoea
has had periods in past but none for 6 months
causes of secondary amenorrhoea
pregnancy/breastfeeding sheehans syndrome - pituitary failure contraception - depoprovera PCO thyroid disease/cushingoid etc early menopause raised PRL hypothalamic eg weight change, stress androgen secreting tumour ashermans syndrome - intrauterine adhesions
Exams and tests for secondary amenorrhoea
BP, BMI, hirsutism, acne, cushingoid enlarged clitoris/deep voice abdominal/bimanual pregnancy test and urine dipstick for glucose bloods - FSH,LH,PRL,TSH, oestradiol pelvic USS
BMI aim in secondary amenorrhoea
20-25
Premature ovarian insufficiency
HRT until 50
emotional support and check for fragile X
Risks associated with PCOS
DM, CVS, endometrial hyperplasia
PCO
small peripheral ovaries, 20% women, common in adolescents
PCOS
irregular ovulation so irregular cycle
plenty E but increased androgens
underlying insulin resistance
Managing PCOS
weight/exercise - increases SHBG
anti-androgen eg CHC, spironolactone
endometrial proliferation - CHC, progestogens, mirena IUS
fertility - clomifene/metformin
